Global Health and Foreign Policy Blog

The Washington Post had a pretty good review of PEPFAR last week. Unfortunately, it concluded with the misleading point that Zimbabwe has seen the largest declines in HIV prevalence in Southern Africa, while its PEPFAR-funded neighbors “lag behind.” SAIS International Health Policy student Ilaria Regondi sets the record straight in this letter to the Washington Post, reprinted below. The Post called her letter “Zimbabwe’s Lethal HIV Solution,” but I think her original title, “Is State Failure an Antidote to AIDS?” gets the point across better.

“Regarding the Feb. 20 article “African AIDS Crisis Outlives $15 Billion Bush Initiative”: According to the article, “economic collapse has coincided with fundamental social change” to decrease the rate of HIV infection in Zimbabwe.

Nevertheless, it is rising mortality — resulting from hardship and poverty — that has been instrumental in effecting change. As mortality rates increase, the pool of infected people and the risk of new infections shrink, and — statistically speaking — this decreases HIV rates.

Death, then, acts as a powerful incentive for behavioral change, but it can hardly be prescribed as the ideal antidote to AIDS. While the health benefits of embracing monogamy are obvious, the cause of this shift (poverty) should also be a cause for widespread concern.

Skyrocketing unemployment and social disruption have also played a part, at once reducing mobility and increasing migration. While the former lessens the risk of infection, the latter inflates other countries’ HIV rates while letting Zimbabwe benefit.

When a country with 150,000 percent inflation and a despotic ruler flaunts achievements that no one else can claim, perhaps a little more caution is in order.”

Ilaria Regondi